No / To estimate the clinical and cost-effectiveness of using a skin protectant (Cavilon No Sting Barrier Film [NSBF] or Cavilon Durable Barrier Cream [DBC]; 3M) compared with not using a skin protectant in the management of venous leg ulcers (VLUs), in the UK. Method: A decision model was constructed depicting the patient pathways and associated management of a cohort of patients with and without a Cavilon formulation, plus dressings and compression. The model was based on the case records of a cohort of matched patients from The Health Improvement Network (THIN) database, who were first diagnosed with a VLU between 1 Jan 2008 and 31 Dec 2009. The model estimated the costs and outcomes of patient management over 6 months and the cost-effectiveness of using a Cavilon formulation relative to not using a skin protectant. Results: Patients' mean age was 80.2 years and 61% were female. Sixty-five per cent (n=166) of Cavilon patients received NSBF, and 35% received DBC. Between 6% and 9% of VLUs were healed at 6 months and 53–66% became infected. Healing was affected by a patient's age (OR: 0.944 for each additional year), but not by gender, level of exudate or wound size. There was a significantly greater reduction in wound size among patients in the NSBF group than in the other two groups (p < 0.001). Additionally, there was no significant difference in the initial wound size of those VLUs that did and did not heal in the two Cavilon groups; however, initial size of the VLUs that healed in the control group was significantly smaller than those that did not (p<0.001). Resource use was similar between the three groups. Patients were predominantly managed by practice nurses, with a mean 37–38 nurse visits over the study period. Patients' dressings were changed, on average, every 4–5 days, with a mean of 3 dressings under a compression bandage. The total 6-monthly NHS cost of managing a VLU was ∼£2200. Practice nurse visits were the primary cost driver, accounting for up to 58% of the 6-monthly NHS cost, whereas dressings accounted for < 10% of the cost. Conclusion: Use of NSBF leads to significantly greater wound size reduction than that observed in the other two groups and may facilitate the healing of larger wounds without increasing costs. Hence, use of NSBF for peri-wound skin protection in patients with exuding VLUs is the preferred treatment strategy. / 3M Health Care, manufacturers of Cavillon NSBF and Cavillon DBC

Yes / A community-based occupational therapy intervention for people with mild to moderate dementia and their family carers (Community Occupational Therapy in Dementia (COTiD)) was found clinically and cost effective in the Netherlands but not in Germany. This highlights the need to adapt and implement complex interventions to specific national contexts. The current trial aims to evaluate the United Kingdom-adapted occupational therapy intervention for people with mild to moderate dementia and their family carers living in the community (COTiD-UK) compared with treatment as usual. Methods/Design This study is a multi-centre, parallel-group, pragmatic randomised trial with internal pilot. We aim to allocate 480 pairs, with each pair comprising a person with mild to moderate dementia and a family carer, who provides at least 4 hours of practical support per week, at random between COTiD-UK and treatment as usual. We shall assess participants at baseline, 12 and 26 weeks, and by telephone at 52 and 78 weeks (first 40 % of recruits only) after randomisation. The primary outcome measure is the Bristol Activities of Daily Living Scale (BADLS) at 26 weeks. Secondary outcome measures will include quality of life, mood, and resource use. To assess intervention delivery, and client experience, we shall collect qualitative data via audio recordings of COTiD-UK sessions and conduct semi-structured interviews with pairs and occupational therapists. Discussion COTiD-UK is an evidence-based person-centred intervention that reflects the current priority to enable people with dementia to remain in their own homes by improving their capabilities whilst reducing carer burden. If COTiD-UK is clinically and cost effective, this has major implications for the future delivery of dementia services across the UK. / This is independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0610-10108). The VALID research team acknowledges the support of the National Institute of Health Research Clinical Research Network. This research is sponsored by North East London NHS Foundation Trust (NELFT).

陸根書. / 論文(博士)--香港中文大學, 1999. / 參考文獻 (p. 194-205) / 中英文摘要. / Available also through the Internet via Dissertations & theses @ Chinese University of Hong Kong. / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest dissertations and theses, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Lu Genshu. / Lun wen (Bo shi)--Xianggang Zhong wen da xue, 1999. / Can kao wen xian (p. 194-205) / Zhong Ying wen zhai yao.

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Stormwater Management (SWM) or Best management practices (BMPs) treat the stormwater runoff that carries pollutants. Pollutants in the waters and in the stormwater, negatively impact the environment, the ecology, and natural resources. Stormwater Control Measures (SCM) are used in different projects to improve water quality and quantity. This thesis aims to understand the connection between SWMs, the economy, and environmental sustainability. This thesis evaluates the cost-effectiveness of SWMs in Mediterranean climates. The research aims to guide the next project managers to choose better SWMs based on cost-effectiveness, socio-economic, and environmental implications. Various studies suggest that the terms SWM, SWM, and SCM are used interchangeably. The research methodology uses a mix of qualitative and quantitative data analysis The research was conducted in Los Angeles at the request of UCLA. Therefore, it focused on water quality improvement projects in Los Angeles. The costs for the projects, areas, and whatSWMs are used will be acquired through data gathering and personal communication with experts. This thesis compares several projects which include different SWMs. It calculates the cost-effectiveness with two different methods, firstly, the cost per drainage area, and secondly, the cost per pollutant removed. Data is gathered from the city of LA and other secondary data sources to calculate the cost-effectiveness. The calculation results showed that the Glenoaksproject and the Machado lake project were the most cost-effective. Glenoaks utilizes infiltration wells and grass swales, and the Machado lake is a large wetland. Based upon these facts, generally, wetlands and grass swales can be recommended for Mediterranean climates. The expensive total costs of SWMs or their inability to remove pollutants can strongly affect the cost-effectiveness of some projects, and produce a negative impact on the economy. Quantitative assessment of study investigates cost-effectiveness of SWMs and for highlighting its economic impact. For qualitative assessment thematic analysis of 14 sample studies related to stormwater management (SWM) was carried out. Findings reveal that 78% of sample studies reflect the themes associated with the positive economic impact of SWMs. Additionally, the sample studies confirm a 76% positive impact of SWMs on the environment and ecology of the region. Further research with better data and more accurate calculations are needed. It would be beneficial if other factors such as recreation and unquantifiable factors such as the aesthetic improvements and community benefits were incorporated into or considered together with the cost-effectiveness for future projects.

Thesis (D. Tech. (Electrical Engineering)) -- Central University of Technology, Free State, 2014 / For a sustainable and clean electricity production in isolated rural areas, renewable energies appear to be the most suitable and usable supply options. Apart from all being renewable and sustainable, each of the renewable energy sources has its specific characteristics and advantages that make it well suited for specific applications and locations. Solar photovoltaic and wind turbines are well established and are currently the mostly used renewable energy sources for electricity generation in small-scale rural applications. However, for areas in which adequate water resources are available, micro-hydro is the best supply option compared to other renewable resources in terms of cost of energy produced. Apart from being capital-cost-intensive, the other main disadvantages of the renewable energy technologies are their resource-dependent output powers and their strong reliance on weather and climatic conditions. Therefore, they cannot continuously match the fluctuating load energy requirements each and every time. Standalone diesel generators, on the other hand, have low initial capital costs and can generate electricity on demand, but their operation and maintenance costs are very high, especially when they run at partial loads. In order for the renewable sources to respond reliably to the load energy requirements, they can be combined in a hybrid energy system with back-up diesel generator and energy storage systems. The most important feature of such a hybrid system is to generate energy at any time by optimally using all available energy sources. The fact that the renewable resources available at a given site are a function of the season of the year implies that the fraction of the energy provided to the load is not constant. This means that for hybrid systems comprising diesel generator, renewable sources and battery storage in their architecture, the renewable energy fraction and the energy storage capacity are projected to have a significant impact on the diesel generator fuel consumption, depending on the complex interaction between the daily variation of renewable resources and the non-linear load demand. V This was the context on which this research was based, aiming to develop a tool to minimize the daily operation costs of standalone hybrid systems. However, the complexity of this problem is of an extremely high mathematical degree due to the non-linearity of the load demand as well as the non-linearity of the renewable resources profiles. Unlike the algorithms already developed, the objective was to develop a tool that could minimize the diesel generator control variables while maximizing the hydro, wind, solar and battery control variables resulting in saving fuel and operation costs. An innovative and powerful optimization model was then developed capable of efficiently dealing with these types of problems. The hybrid system optimal operation control model has been simulated using fmincon interior-point in MATLAB. Using realistic and actual data for several case studies, the developed model has been successfully used to analyse the complex interaction between the daily non-linear load, the non-linear renewable resources as well as the battery dynamic, and their impact on the hybrid system’s daily operation cost minimization. The model developed, as well as the solver and algorithm used in this work, have low computational requirements for achieving results within a reasonable time, therefore this can be seen as a faster and more accurate optimization tool.

Submitted in fulfilment of the academic requirements for the Degree of Magister Technologiae: Civil Engineering, Department of Civil Engineering and Surveying, Faculty of Engineering and the Built Environment, Durban University of Technology, 2009. / Infrastructure project costs are being scrutinised more closely and with greater skill and accuracy as projects have become larger, more complex and more expensive, and clients have become more exacting in their requirements. These and other factors compel engineers to design with greater care and in more detail. However, public planners spend very little time generating alternative project options, often presenting decision-makers with only a few poorly differentiated alternatives borrowed ad hoc from other projects. Even more disturbing is that they often devote the greatest amount of decision making resources to the development of a single decision rather than a variety of options. A systematic and iterative analysis of the cost consequences of different design solutions is commonly suggested for infrastructure projects, but rarely happens. There is a growing need to integrate design and costs. This study concentrates on the issue of cost optimisation of infrastructure projects (particularly at the design stage of the project) and applies construction economics, cost planning, cost optimisation and value engineering techniques to the design of such projects. The methodology proposed in this study for the optimisation of cost and design planning is the Infrastructure Cost Planning Model. This model divides the planning of a project into four stages and utilises twelve Cost Report Forms across these stages. The Cost Report Forms define in a comprehensive, precise and verifiable manner the essential characteristics of a deliverable component. They are used to measure, quantify, verify and audit the different design options. By means of the Cost Report Forms, the Infrastructure Cost Planning Model enables the client to select a combination of alternatives and evaluate a number of possible design options – with their cost implications – at each stage of the design process. This i promotes transparency and accountability, and enables consultants and clients to have greater control over the planning process and overall costs. Two case studies on infrastructure related projects were conducted and confirm that the Infrastructure Cost Planning Model can reduce costs. This study demonstrates that it is possible to overcome the problem of over expenditure by introducing cost effective design decisions prior to the infrastructure design approval process. The Infrastructure Cost Planning Model can improve infrastructure standards and procure design in a cost effective, equitable, competitive and transparent manner. This study contributes to the underdeveloped area of cost planning and forecasting of infrastructure projects. The findings are relevant to the South African government's infrastructure service delivery programme and the general issue of affordable infrastructure services.

Thesis (MBA (Business Management))--University of Stellenbosch, 2006. / ENGLISH ABSTRACT: Since packaging materials comprise a substantial percentage, namely 35% of the entire input cost on a fruit farm, the four largest fruit producers in the Western Cape decided in 1988 to erect their own corrugated cardboard plant at Worcester, namely A P L Cartons. The driving force of the company is to minimise the longterm input cost of packaging material in a sustainable manner. Therefore cost effectiveness and competitiveness had to be a distinct characteristic of the company. The company's corporate strategy is aimed at strong growth by means of a best value strategy that adds to the value of clients' products and production processes. Despite a well formulated strategy, it has been found that key targets are not met according to expected standards. While profitability, productivity, cost effectiveness and the workers' moral are on the decline, there is a constant rising in downtime, quality rejections and waste at the plant. The problem is further complicated when one takes into account that the company still succeeds in maintaining its specific growth performances. Yet, this take place at the expense of effectiveness in the plant. A literature study will be conducted to establish the general causes for strategic gaps at companies. Against this background the reasons for the gap between the strategic direction and the company results at A P L Cartons will be identified. A literature study will also be conducted to determine the project management and strategic management approach to goal achievement. This will be developed into a management model for bridging the strategic gap at A P L Cartons. An investigation into companies that have experienced project failures revealed two main causes, namely that such companies: a) Don't have a framework for projects; or b) Don't have a distinct strategic direction. Therefore strategic, as well as project managers must act as facilitators who rely on delegating and co-ordinating in order to create conditions for performance instead of failure. From the study it appeared that the main reasons for strategic gaps at A P L Cartons are the following, namely : a) Although a definite strategic direction has been formulated, the company does not have a proper framework for the implementation of its strategy, projects and initiatives. b) Functional managers do not contribute on a cross-functional basis to the training and development of skills lacking in other departments. c) The development of functional and competitive strategies don't go further merely than their formulation. Therefore they can't support the implementation of corporate strategy. d) Senior management is too intent on operational detail, so much so that a helicopter like vision of a strategic direction and its implementation mostly is lacking. e) There doesn't exist a procedure for the identification, handling and managing of critical issues for strategy implementation. The study suggests two related tools for the handling of critical matters, namely a critical issue management form and a critical issue register. This forms part of a management tool that can be utilised alongside a management model and management framework, especially developed for A P L Cartons to strive for reaching strategic goals. The framework was developed after discovering that both strategy and projects can be managed within the same framework of reference since both share the same origin and substructure. The origin is found in corporate objectives, while a directional value system provides its substructure. / AFRIKAANSE OPSOMMING: Aangesien pakmateriaal 'n wesenlike gedeelte, naam1ik 35 persent van totale boerdery insetkoste in die vrugtebedryf beslaan, het die vier grootste vrugteprodusente in die Wes-Kaap in 1988 besluit om hul eie riffelkarton vervaardigingsaanleg, naamlik A P L Cartons te Worcester op te rig. Die dryfkrag van die maatskappy is om pakmateriaal insetkoste oor die langtermyn handhaafbaar te minimiseer. Daarom moes kostedoeltreffendheid en mededingendheid 'n onderskeidende kenmerk van die maatskappy wees. Die korporatiewe strategie van die maatskappy is ingestel op versnelde groei by wyse van 'n waarde-strategie wat waardetoevoegend tot kliente se produkte en produksieprosesse is. Ondanks 'n goed geformuleerde strategie, word gevind dat sleuteldoelstellings nie teen verwagte standaarde bereik word nie. Terwyl winsgewendheid, produktiwiteit, kostedoeltreffendheid en werknemermoraal afneem, styg staantye, kwaliteitsafkeurings en afval in die aanleg. Die probleemstelling word verder gekompliseer indien in ag geneem word dat die maatskappy steeds daarin slaag om sy reele groeiprestasie voort te sit. Dit vind egter plaas ten koste van doelmatigheid in die aanleg. Daar sal op 'n literatuurstudie staatgemaak word om die algemene oorsake van strategiese gapings by ondernemings vas te stel. Teen die agtergrond sal die oorsake vir die gaping tussen die strategiese rigting en maatskappyresultate van A P L Cartons identifiseer word. 'n Verdere literatuurstudie sal onderneem word om vas te stel wat onderskeidelik die projekbestuursbenadering en strategiese bestuursbenadering tot doelwitbereiking is. Daaruit sal 'n bestuursmodel vir die oorbrugging van die strategiese gaping by A P L Cartons ontwikkel word. 'n Ondersoek na projekmislukkings by maatskappye identifiseer twee hoof-oorsake daarvoor, naamlik dat sulke maatskappye : a) Nie oor 'n raamwerk vir projekte beskik nie; of b) Nie oor 'n duidelike strategiese rigting beskik nie. Daarom moet strategiese en projekbestuurders optree as fasiliteerders wat staatmaak op delegering en koordinering om die omstandighede te skep vir prestasie pleks van mislukking. Uit die ondersoek is vasgestel dat die hoof-oorsake vir strategiese gapings by A P L Cartons die volgende is, naamlik : a) Alhoewel 'n duidelike strategiese rigting geformuleer is, beskik die maatskappy nie oor 'n raamweek vir die implementering van strategie, projekte en inisiatiewe nie. b) Funksionele bestuurders dra nie kruisfunksioneel by tot die opleiding en ontwikkeling van vaardighede wat in ander departemente ontbreek nie. c) Funksionele en mededingende strategiee word nie verder as die formulering daarvan ontwikkel nie. Gevolglik rugsteun dit nie die korporatiewe strategie tot implementering nie. d) Senior bestuur is te ingegrawe in operasionele detail, sodat 'n helikoptervisie oor strategiese rigting en implementering meestal ontbreek. e) Daar bestaan nie 'n werkswyse vir die identifisering, hantering en bestuur van kritiese kwessies vir strategie-implementering nie. Die ondersoek stel twee instrumente wat met mekaar verband hou voor vir die hantering van kritieke kwessies naamlik 'n kritieke kwessie bestuursvorm en 'n kritieke kwessie register. Dit vorm 'n bestuursinstrument wat saam met 'n bestuursmodel en -raamwerk, wat vir A P L Cartons ontwikkel is, gebruik kan word om strategiese doelwitbereiking na te streef. Die raamwerk is ontwikkel nadat vasgestel is dat strategie en projekte binne dieselfde verwysingsraamwerk bestuur kan word, omdat beide dieselfde oorsprong en onderbou deel. Die oorsprong word gevind by korporatiewe doelstellings, terwyl 'n rigtinggewende waardestelsel die onderbou daarvoor verleen.